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Diabetes Foot Clinic

This is a dedicated specialist multidisciplinary foot clinic for patients with acute diabetic foot complications.

The main team includes both medical and surgical consultants, specialist podiatrists, a clinic assistant and an orthotist. However, there are also microbiology and radiology specialists readily available if needed. Care is undertaken in both outpatient and inpatient settings.

The foot clinic can be found in the Elsie Bertram Diabetes Centre. This is a multidisciplinary centre with a variety of professions involved in diabetes care, covering central Norfolk, and the surrounding areas.

The Elsie Bertram Diabetic Foot Clinic is open Monday to Friday and runs by appointment but if you are an existing patient you can arrange for a follow-up in clinic by contacting them directly on 01603 288522, also if you are concerned about your foot condition you can contact the Foot Clinic by phoning the same number, if we are unable to answer your call immediately, please leave a message and we will get back to you as soon as possible.

Whilst the foot clinic is usually run by the podiatrists, the other members of the team are always available. We also run specialist foot clinics as well. These are the medical foot clinic that runs on alternate Thursday mornings run by Dr K Dhatariya, Consultant Diabetologist. There is a vascular foot clinic that runs on the other Thursdays with Dr K Dhatariya and Mr D Morrow, one of our vascular surgeons. In addition, Mrs R Hutchinson, Orthopaedic Surgeon holds an Orthopaedic Foot Clinic once a month one specialising in bone problems in the feet. Dr K Dhatriya is also present.

New patient referrals are accepted from all healthcare professionals. A new patient appointment will take approximately one hour; during this time you will be asked about your general health, diabetes control, current medication and history of foot problem. In order to help us complete our assessment we ask that you provide an up-to-date list of medication (ideally by bringing your most recent repeat prescription). We will assess the blood supply and nerves in your feet. Subsequent appointments will take 30-45mins.

The Norfolk and Norwich University Foundation Hospital is a teaching hospital, this means that there maybe student doctors, nurses or podiatrists in clinic, and we will discuss your foot problems with them, if you would rather not have a student present please let the podiatrist know.

We aim to be an academic unit, and as such, patients attending the foot clinic may be asked to participate in clinical studies being undertaken in the department if they are deemed appropriate. Patients are under no obligation to take part and will be made aware that if they decline participation their ongoing care within the foot clinic will not be affected.

Diabetes can lead to foot complications as a result of nerve damage, which can lead to loss of sensation in your feet and damage to the blood vessels that supply your feet. Diabetes can also increase your risk of developing an infection in your skin or bones. These three factors make your foot more susceptible to injury and can lead to other complications including:

Referrals are accepted from all healthcare professionals for the acute foot conditions mentioned earlier. If you are concerned you have an acute foot problem please contact your regular healthcare professional.

If you have any other foot problems corn, callus, nail care issues etc you can self refer to:

One of the main skills a podiatrist has is debriding hard skin (callus) and removal of unhealthy infected tissue using a scalpel, this is done under clinical conditions and is generally painless. If you attend the foot clinic with an ulcer or gangrene, your verbal permission will be sought to debrided the affected site.Another form of debridement used in the foot clinic is Larvae therapy; this is used when there is too much unhealthy tissue to remove with a scalpel. You will have to attend the clinic once or twice a week to have fresh larvae applied. Callus and unhealthy tissue are removed to promote healing, reduce pressure and risk of infection

If you have an ulcer on the sole of your foot or a Charcot foot it is important to reduce the pressure. You may be offered one of a variety of sandals or boots to reduce the pressure on the affected foot. These off-loading devices include;

Plaster Casts

Off-the-shelf removable/non-removable walker

Bespoke removable walker

Temporary therapeutic walker

Total contact cast are non-removable and are made from polyester. They are the gold standard treatment for off-loading problem feet. Before you are offered a cast the podiatrist will advise you on the risks associated with the cast and how it will affect your mobility. If you are offered a total contact cast you will need to attend the weekly casting clinic for review.

Diabetic foot ulceration is frequently complicated by infection. Infections can delay or prevent healing. When you attend the foot clinic your foot will be assessed for infection and swab, tissue or bone samples may be taken. If required we will arrange for you to receive antibiotic therapy.

In some instances it may be necessary for patients to be admitted to hospital, this occurs for two main reasons

Infection not responding to treatment

Reduction in blood supply threatening the viability of the limb.

If this is the case you will be reviewed by either a consultant or registrar to arrange emergency admission from the foot clinic. After discharge from hospital you will be reviewed in the foot clinic as an outpatient.

Medical/Vascular Foot Clinic

If your foot condition is failing to respond you will be seen in either the Medical or Surgical foot clinics, depending on the underlying reason for your foot condition. These are consultant led clinics, where your diabetes and foot condition.will be assessed further and a long term treatment plan agreed.

When you foot condition has begun to improve you may well be offered hospital footwear. These shoes are designed to fit your foot shape and reduce the chances of future foot problems developing. If your foot shape has altered as a result of Charcot or amputation it is especially important that you have well fitting footwear.

Once your foot condition has healed or if you are not suitable for the off-loading devices mentioned earlier, you maybe offered an appointment in the F-scan clinic at the Norwich Community Hospital. This clinic utilises specialist computer technology to analysis the amount of pressure that goes through your foot and ulcer site while you are walking. The results of these investigations will then be used to develop an insole reducing the amount of pressure to the ulcer site. This appointment takes one hour.

Once your foot problem has healed you will no longer need to attend the Foot Clinic. However ongoing podiatry care will be essential to reduce the chances of future foot problems. You will be offered an appointment in the Diabetic Outreach Clinic at Norwich Community Hospital or in one of the Community Podiatry Clinics.